Rationale:To report a rare case of severe atypical hemolytic-uremic syndrome (HUS) in a patient who presented with vitreous hemorrhage and tractional retinal detachment (TRD) in both eyes. To our knowledge, this is the first reported case of atypical HUS complicated with bilateral TRD in the literature.Patient concerns:A 20-year-old man with atypical HUS demonstrated bilateral visual acuity of hand motion at 30 cm.Diagnoses:Dilated fundus examination revealed diffuse intraretinal hemorrhage with vascular engorgement, neovascularization of the disc, and neovascularization elsewhere bilaterally. Fluorescein angiography revealed bilateral proliferative retinopathy, retinal hemorrhage, and a large nonperfusion area with extensive neovascularization. Intravitreal antivascular endothelial growth factor (ranibizumab) injection was administered in both eyes, but his ophthalmic condition did not improve, and TRD developed bilaterally. Therefore atypical HUS complicated with bilateral TRD was diagnosed.Interventions:Pars plana vitrectomy was performed with panretinal photocoagulation and silicone oil tamponade in the right eye.Outcomes:After the pars plana vitrectomy of right eye, the retina was well-attached after surgery, but visual acuity remained poor. Visual evoked potential examination showed poor waveforms bilaterally, which suggested ischemic optic neuropathy.Lessons:Atypical HUS can cause systemic thrombotic microangiopathy, resulting in ischemic retinal changes. These ischemic retinal changes can then cause hypoxia, which triggers production of angiogenic factors and subsequently causes retinal vascular hyperpermeability, retinal and vitreous neovascularization, fibrovascular proliferation, vitreous hemorrhage, and TRD, in a manner similar to that of other ischemia-induced proliferative retinopathies. Despite successful surgery in the right eye, our patient's visual acuity did not improve, possibly because of severe and generalized ischemia of intraocular tissue, which resulted in ischemic optic neuropathy.
Cycling is a very popular activity worldwide and cyclists often listen to music while riding. This usually involves the use of a portable music player or a cellphone, which may present safety problems. Since these devices may easily distract the attention of the cyclist. This is a matter that has not received much attention but has great relevance to traffic safety. In this study, the attention level of cyclists was measured and recorded as electroencephalograms (EEGs), and discrete wavelet transforms (DWTs) based on Daubechies wavelets were used to extract the EEG features. Six different cycling activity patterns were investigated and eigenfunctions were used to classify the attention level. After feature extraction by the DWTs, support vector machines (SVMs) and general regression neural networks (GRNNs) were employed to recognize different states of mind associated with specific cycling activities. In Case I, the recognition rates of the SVM and GRNN were used to determine the state of mind associated with two different cycling activities, riding in a straight line and riding around obstacles. In Case II, rider vigilance was investigated using the SVM and GRNN for eight different cycling scenarios. The experimental results validated the proposed method and showed the brainwave patterns to be clearly associated with different cycling activities. The experimental results showed that looking at a cellphone screen or engaging in a call caused riders to miss very obvious peripheral stimuli and the use of a cellphone by a cyclist is a clear danger to the rider and traffic safety.
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